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General NPI Number Information
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NPI Number | 1568206746
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Entity Type | Individual
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Provider Name | SHREYA REDDY SWARNA D.M.D
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Gender | Female
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Dates
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Enumeration Date | 06/21/2024
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 845 S PERRYVILLE RD UNIT 127
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City | ROCKFORD
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State | IL
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Zip | 61108-4340
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Country | US
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Telephone | 815-323-0750
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Fax |
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Provider Business Mailing Address
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Address Line | 3259 FOSTERBURG RD APT 1
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City | ALTON
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State | IL
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Zip | 62002-7367
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Country | US
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Telephone | 815-323-0750
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.035188
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License Number State | IL
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